“The Voices of Lived Experience” highlights the changes people need across health, housing, mental health and substance use services
It brings forward the insights of 385 people from marginalised and socially-excluded communities across the Bristol area – one of the largest engagement exercises of its kind.
These insights call for action from leaders to respond to communities whose voices are seldom heard and review strategies, programmes and plans alongside the people most affected by them.
Download our executive summary, the full report, or continue reading below.
Developed by TCF in partnership with Keele University and Midlands Partnership University NHS Foundation Trust (MPFT) through NIHR funding, the report gathers perspectives through:
- 311 surveys
- 21 in‑depth interviews
- 8 focus groups
We asked about people’s experiences of homelessness, substance use, mental health and involvement in the criminal justice system. There was a clear message from contributors.
We are not hard to reach – systems are hard to access.
Themes – what did people tell us?
- Stigma and discrimination continue to block access to fair, compassionate care.
- Trauma‑informed practice is widely claimed but rarely meaningfully implemented.
- Neurodivergent people face misdiagnosis, misunderstanding and inaccessible processes.
- Substance use services lack integration, modernisation and flexibility, particularly in response to new and emerging drug trends.
- Long waits, service fragmentation and siloed systems leave people unsupported during crisis.
- Housing environments are often unsafe or unsuitable, reinforcing instability rather than recovery.
These are real barriers shaping real lives – nearly 400 voices calling for bold, system-wide transformation.
What are we asking leaders to do?
- Embed lived experience at every stage of decision‑making, not as a token gesture but at scale.
- Focus on integration, ensuring mental health, substance use, neurodiversity and housing services work as joined‑up pathways – not isolated islands.
- Adopt genuine trauma‑informed practice, backed by staff training, consistent standards and accountability.
- Design services around people, recognising that stigma, trauma, neurodiversity, poverty and homelessness intersect in ways current models fail to meet.
- Deliver safer housing environments, with care quality in mind, not just tenancy enforcement.
- Fund modern, evidence‑led approaches to substance use, including harm reduction, support for stimulant and new psychoactive substance use, and multiple recovery pathways.
- Improve accessibility, from plain‑language communication to flexible appointments, remote engagement options, and support for people without stable addresses.
Listening to marginalised communities is not optional – it is essential
Participants offered their time, perspectives and personal stories not for recognition, but to inform change. Their knowledge is precise, informed, and urgently needed. People who have been marginalised are experts in the systems they navigate.
Their insights show that meaningful involvement can reshape how services understand need, measure outcomes, and design support that truly works. Strategic partners across health, housing, criminal justice, substance use and community services are urged to engage with the findings to support the transformational change participants are calling for.
A call to leaders: Read the report. Reflect on its insights. Build with – not for – communities.